Consent Form
: ……………………………………………………… ……………………………………………………… Phone: …….………………………………………………………. …………………………………………………………….. Health insurance card no. (if available) ……………………………………………………………………………….. I read, it was illustrated to me in a known language and I fully understood the Information Notice written by the Italian Medicines Agency (AIFA) about the ...